FORM-BTRC: VSAT

Bangladesh Telecommunication Regulatory Commission

IEB Bhaban, Ramna, Dhaka, Dhaka-1000

Application Form for New VSAT License

( For Only Point to Point Data Communication excluding Voice Communication ) [ See Section 36(5) of the Bangladesh Telecommunication Regulation Act, 2001 ]
[ Please see the General Information and Guidelines ]
[Incomplete application will not be entertained and summarily rejected]

A. Applicant Profile 1. Name of Applicant: (Not to be an individual)

Address of Registered Office.

2. Mailing Address:
Full Address for Communication.

Telephone Cell Fax E-mail Website

3. Name of Contact Person:

Name and address of the authorized person for contract and signing the application (In case of a Limited Company, Copy of resolution of Board of Directors to be attached). Telephone Cell Fax E-mail Website

B. Service Profile 1. Type of Service to be provided for which license is sought: [ ] User [ ] Provider [ ] Provider with Hub

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FORM-BTRC: VSAT 2. Location of installation:

Location of installation (Description of equipments, title deeds to be submitted).

3. Destination Location:
The destination location of the VSAT circuit.

4. Business plan:
Business plan with Service area sketch map and Nature of servicestogether with Details of technical information/list of equipments for which license is sought for (separate sheet may be used if necessary).

5. Name & Address of VSAT Provider:

Name and address of VSAT Provider, in case of VSAT user (Copy of agreement with the particulars of License of VSAT Provider to be submitted).

6. Name & Address of Foreign Partner:

Name and address of foreign partner, in case of VSAT Provider (Copy of agreement with Government/local agent to be attached with full particulars of foreign partner/investors together with Clearance Certificate from Bangladesh Bank for foreign currency remittance).

C. Technical Profile 1. Satellite Name:

Name of the Satellite to be used for communication.

2. Bandwidth:
Bandwidth for Uplink and Downlink of VSAT. Uplink Downlink

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FORM-BTRC: VSAT 3. Particulars of Speed of Data:

Particulars of speed of data under use showing the KBPS/MBPS for the proposed service.

D. Particulars of Bank draft / Pay orders (license fee/ evaluation fee etc.): Type of Payment: a. Name of Bank : b. No. :
[ ] P.O. [ ] D.D. [ ] B.D. [ ] B.C.

c. Date :

E. Documents to be Enclosed for New VSAT License:

[

Use tick [] mark in the appropriate box Serial 1. 2. Type of firm: Items Application in a Letter Head Pad. (a) Limited Company (b) Partnership Firm or (c) Sole Proprietorship 3. 4. 5. 6. Bank Solvency Certificate. Whether declared insolvent any time, if so the subsequent discharge certificate-to be attached. Whether the Applicant is a Bank Defaulter (If not enclose a certificate to this effect from the Bangladesh Bank). Copy of Registration Certificate along with Memorandum of Association, partnership etc. as the case may be, to be attached. ( if applicable ) Copy of Trade License. Latest Income Tax Clearance Certificate with TIN number. Undertaking on non judicial stamp of Tk. 150/- sworn before the notary public of Bangladesh about not to take any activity over VOIP / WiMAX business. Whether the applicant is a convict, if so State the date of conviction and Term of sentence with expiry date of sentence. Attached Not Attached Remarks

7. 8. 9. 10.

F. Declaration :
1. 2. Has any Application for the License of VSAT been rejected before? (if yes, please give date of application and reasons for rejection)

Yes

No

Has any License issued previously to the Applicant/any Share Holder/Partner been cancelled?

Yes

No (if yes, please give reason and date of cancellation)

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FORM-BTRC: VSAT
3. Do the Applicant/any Share Holder/Partner hold any other Licenses from the Commission?

Yes No (if yes, please give installation address of those license)

4. 5. I/We hereby certify that I/We have carefully read the terms and conditions, for the license and I/We undertake to comply with the terms and conditions therein. I/We do hereby declare that the particulars and information set forth and furnished as above are true to the best of my/our knowledge and I/We have not suppressed any material fact. And also do hereby undertake that in the event license as sought for is granted I/We shall faithfully comply with and abide by all the terms and conditions of the license. I/We hereby certify that I/We have carefully read the section 36 of Bangladesh Telecommunication Regulation Act, 2001 and I/We are not disqualified from obtaining the license. I/We understand that if at any time any information furnished for obtaining the license is found incorrect then the license if granted on the basis of such application shall deemed to be cancelled and shall be liable for action as per Bangladesh Telecommunication Regulation Act, 2001.

6. 7.

Date: Place:

Signature Name of the Applicant/Authorized Signatory with Seal

Note:
After getting the VSAT license, the Entity shall have to duly apply for renewal of the said license; otherwise the license shall be cancelled. In that case the Entity shall dismantle and sealed the VSAT equipment and hand over to the BTRC. Column not relevant for the purpose need not be filled in and in appropriate cases be struck off. Separate sheet may be used where necessary. The Fees/Charges are given in circular which is given in the website (www.btrc.gov.bd ). Application without the submission of complete documents and information will not be accepted. Payment should be made by a Pay order/ Demand Draft in favor of Bangladesh Telecommunication Regulatory Commission (BTRC). All Fees and Charges are non refundable.

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